Una Avventura nell L'Ospedale

On Thursday, May 11th Roger went for a bike ride, one he's done dozens of times before.  As he neared home in Pienza, he hit the climb called "Rampino Val d'Orcia" (Ramp up the Valley of the Orcia).  With 3.3 km left to go, he started to feel really punky, so he did something he's done only once in his life before...got off the bike and walked.  By the time he reached his apartment in Pienza, he was so light headed he could no longer walk, his face was covered in a sheet of sweat, and his breath was coming in racking gasps.

Next day, when the town doctor's office opened at 5:00pm, he went and sat (for over an hour), waiting his turn to see the doctor.  He got a thorough exam...and was instructed to go directly to the regional hospital in Nottola, about 18 km away.  We got there about 8:00pm and went directly to the emergency room (called Pronto Soccorso in Italy).  We were triaged promptly and then sat for more than two hours before a nurse came and got Roger.

This is where the real adventure began.

Roger immediately got an EKG and was diagnosed with auricular arrhythmia...an irregular heartbeat. The cardiologist said he would have to be admitted and undergo further tests.  It was well after midnight when the cardiologist performed the ultrasound that confirmed the arrhythmia and 2:00am before he got situated in the cardiac ward.  The nurses were great; they brought pillows and a blanket for Carol, so she could sleep what was left of the night on a nearby couch.  Before they let Roger try to get some sleep, they performed another EKG.

Bright and far too early the next morning, Carol left for Chiusi to pick up a last-minute rental car.  Minutes after she left, a second cardiologist came by for a consult.  Based on the EKG, she said Roger needed atrial fibrillation...but before they could do that they had to scope the interior of his heart (called transesophageal ecocardiography) to make sure there was no coagulated blood lurking there to precipitate a stroke.

Note that Roger was not offered any options.  He was told this is what they were going to do.  But he first had to sign a permission that the cardiologist explained exempted them from liability if anything went amiss.  He was administered anesthetic, and when he woke up the cardiologist told him the results of the heart scan were inconclusive.  She was calling in a gastroenterologist to repeat the procedure.

An hour later, the GI doc arrived and explained how his scan would be different.  Then, more anesthetic and when Roger woke up a second time, the cardiologist was smiling.  She said the scan went fine, so they went ahead and the shock to the heart.  That corrected the irregular heartbeat....as confirmed by yet another EKG.

Roger had to stay another night in the hospital for observation, but if all went well he would would be cleared to go home the next day.  After an uncomfortable night, he had a fourth EKG, a second consult with the first cardiologist, and was released from the hospital....tired and sore but with a clean bill of health.

Let's review the bidding here....

• an ER visit
• a heart ultrasound
• blood tests
• four different EKG's
• two anesthesias
• consults with two different cardiologists
• consult with a gastroenterologist
• two scopes of the heart
• the electric shock to correct the heartbeat
• two nights in the hospital's cardiac ward

In the USA, the bill would be how many tens of thousands of dollars?

At the Nottola Regional Hospital the bill was 124€ ($132.33 at the current exchange rate).  Here's the bill:

To be fair, everybody realizes there's no way a health care system can sustain itself by providing that many services for so little money.  The Italian health care system is supported by a tax on income (separate from the hated and oft-evaded general income tax)...the rate slides depending on total income.  For example: a family earning 100,000€ per year would pay 4,900€ to support the healthcare system.  How does that compare to what you...or your employer...pays for your health insurance?

One final point:  In its last ratings of national health care systems, the World Health Organization ranked the Italian health system second of 192 nations (behind only France) at delivering effective health care.  The USA placed 37th.